10 BECKET STREET - TRASH COMPLAINT =s CITY OF SALEM, MASSACHUSETTS
n Wes. BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
/// LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINC&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: In Time: Received By:
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Complaint Number: 2212
Complainant
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Address: Phone:_
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Investigated By: _Date:
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